GI tract

Question 1

GI tract lining is

Answer 1

Squamous epithelium

Question 2

Glandular epithelium may exist in

Answer 2

Illness

Question 3

Barrett’s Oesophagus

Answer 3

Change from squamous epithelium to glandular

Columnar lined lower oesophagus - CELLO

Question 4

Metaplasia

Answer 4

Change in differentiation of a cell from one fully diff type to a different type

Question 5

Stable structure

Answer 5

Stomach lined with glandular epithelium which produces mucins to protect against acidic substances
Acid reflux causes ulceration and damage to oesophageal wall

Question 6

Base of oesophagus undergoes

Answer 6

Adaptive change to endothelium

Mucins newly produced to protect against acid reflux

Question 7

Cause of acid reflux and therefore barrett’s and potentially oesophageal cancer (adenocarcinoma)

Answer 7

Obesity due to pressure forcing acid upwards

Question 8

Process of oesophageal cancer

Answer 8

GO reflux
metaplastic oesophageal glandular epithelium
dysplastic
neoplastic

Question 9

Squamous cell carcinoma

Answer 9

Thought to be caused by smoking and alcohol

Question 10

Helicobacter gastritis
Mechanism
presentation

Answer 10

Lives within mucin
Induce inflammation in stomach
Attract neutrophil polymorphs from surrounding areas

Stomach ache
Ulcers

Question 11

gastric cancer
factors
presentations

Answer 11

smoked, pickled foods

Linitus plastica

low survival due to late presentation

Question 12

coeliac disease

Answer 12

gluten sensitive enteropathy 
blunted villi - villous atrophy 
crypt hyperplasia
increased no lymphocytes
immune reaction to gluten
allergy 
body produces T cells which attack gluten

Question 13

inflammatory bowel disease

Answer 13

Chronic idiopathic inflammatory bowel disease

Crohn’s disease and ulcerative colitis

Question 14

Crohn’s

What is the inflammatory response

Answer 14

Patchy inflammation from anywhere from bowel to anus

Aphthous ulcers extending through bowel wall and sometimes into fatty tissue

Granulomas - inflammatory response

Question 15

Crohn’s disease complications

Answer 15

Inflammation
Perforation
Malabsorption
Neoplasia

Question 16

Ulcerative colitis

Answer 16

Continous condition in mucosa of colon
Cut off between normal and inflamed tissue is obvious
Ulceration in mucosa

Question 17

Diverticular disease

Answer 17

Out pouchings in wall of sigmoid colon
Diverts bowel matter
Inflamed sections may become perforated

Question 18

DD development

Answer 18

Small gaps in mucosa for vessel
Internal high pressure of bowel e.g low fibre
Pressure causes mucosa to push matter through holes
Can perforate once inflamed

Question 19

Colorectal cancer

Who does it affect?

Answer 19

Older people
People with adenomas
Dysplastic epithelium
Growth in mucosa
May be associated with local benign adenomas
Incidence increasing but deaths reduced
Normal epithelium –> adenoma –> colorectal adenocarcinoma

Question 20

Familial adenomatous polyposis

mechanism

Answer 20

Development of 1000s of polyps on surface of colon
APC protein gene is mutated - may be folded or absent
Beta catenin levels rise unmoderated
Beta catenin moves into nucleus binds to DNA and encourages switch on of specific genes which leads to epithelial proliferation and adenoma

Question 21

HNPCC

Answer 21

Hereditary nonpolyposis colorectal cancer

DNA repair protein gene nonactive therefore protein not produced

Question 22

Macroscopic features of colorectal cancer

Answer 22

Brown staining around islands

Question 23

Microscopic features of colorectal cancer

Answer 23

Adenocarcinoma

Question 24

Colorectal cancer - staging and prognosis

Answer 24

Gives pt idea of prognosis

Question 25

resection coding

Answer 25

• R0 - tumour completely excised locally
• R1 - microscopic involvement of margin by tumour
• R2 - macroscopic involvement of margin by tumour

Question 26

prognosis and circumferential resection margin (CRM)

Answer 26

• CRM +ve 20% 5 year survival with 85% risk of local recurrence
• CRM –ve 75% 5 year survival with 10% risk of local recurrence

Question 27

Dukes’ stage and prognosis

Answer 27

• A 95% 5 year survival
• B 75% 5 year survival
• C 35% 5yearsurvival
• D 25% 5 year survival

further spread = worse prognosis